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Mononucleosis: symptoms, infection, course

by Josephine Andrews
Published: Last Updated on 268 views

Mononucleosis is a viral disease that almost everyone will contract at some point in their lives. It is usually transmitted via saliva and is therefore also called kissing disease. However, the disease often does not break out or go unnoticed. When adults become ill, the symptoms are often particularly severe and show up as a sore throat, swollen lymph nodes, fever, and fatigue. Find out here about the most important signs, ways of infection, and therapies.

Mononucleosis: a brief overview

  • Main symptoms: sore throat , swollen lymph nodes, fatigue, fever , enlarged spleen
  • Infection: Via the saliva when kissing or via bodily fluids (sexual intercourse, blood )
  • Diagnostics: Blood test for the Epstein-Barr virus (EBV) and EBV antibodies, throat swab, scanning of the spleen and lymph nodes
  • Treatment: Symptomatic treatment of pain and fever, cortisone in severe cases
  • Possible complications: dangerously swollen throat , ruptured spleen , inflammation of the liver, meningitis, symptoms of paralysis, skin rash

Mononucleosis: symptoms

The glandular fever (infectious mononucleosis, mononucleosis infectiosa, monocyte angina) is caused by the Epstein-Barr virus (EBV). The disease manifests itself primarily in the form of tonsillitis and pharyngitis with severely swollen lymph nodes, fever and fatigue due to glandular fever.

In children, the infection often has few symptoms because their immune system does not yet react strongly to the pathogen. In adults, milder courses can be confused with a flu-like infection. However, severe courses with complications are also possible.

Mononucleosis: main symptoms

Sore throat: Typical for glandular fever is severe sore throat with intense reddening of the pharyngeal mucosa and pronounced difficulty in swallowing. The tonsils and lymph nodes swell, and some patients develop a high fever.

Pronounced fatigue: In the acute phase of the disease, the patients feel extremely exhausted and powerless. They usually recover within a week or two.

In others, however , fatigue , listlessness and a general feeling of illness can persist for a long time – even without the typical symptoms of glandular fever having previously appeared.

Sudden inefficiency is often the first, and sometimes the only sign of the disease, especially in athletes. In some cases, the pronounced dullness lasts for several months.

Swollen spleen ( splenomegaly ): The spleen plays an important role in fighting disease, filtering dead blood cells from the blood. She is particularly challenged during an infection with the Epstein-Barr virus. As the disease progresses, it can swell and sometimes even tear.

Mononucleosis: Complications

Glandular fever is usually uncomplicated. However, serious, sometimes life-threatening complications can also occur.

Severely swollen throat: It becomes dangerous when the immune system reacts so strongly to the virus that the mucous membrane in the throat swells up. This can make swallowing impossible and even hamper breathing .

Ruptured spleen: A severely swollen spleen can rupture from impacts or falls. The severe internal bleeding then creates a life-threatening situation. Patients should therefore strictly avoid the risk of impact injuries in this condition.

Inflammation of the liver ( hepatitis ): The virus can also infect the liver and cause liver inflammation. If this is difficult, the skin turns yellow due to the restricted liver function ( jaundice ) in glandular fever.

Rash: In about five to ten percent of those affected, a patchy, raised (whealed) skin rash forms, the so-called maculopapular exanthema.

Symptoms of paralysis: If the virus reaches the nervous system, it can trigger inflammation there with symptoms of paralysis, which can also threaten breathing.

Inflammation of the brain : The virus can reach the brain . There it can cause brain or meningitis.

Mononucleosis: infection and causes

Mononucleosis is contagious. It is caused by the Epstein-Barr virus (EBV). The pathogen multiplies in the lymphocytes and in the mucous membrane cells in the throat. The virus cannot survive long outside the human body.

routes of infection

EBV is transmitted through body fluids. Since the virus is mainly found in the saliva, it is particularly easy to get infected through close physical contact and kissing. In English-speaking countries, glandular fever is therefore referred to as “kissing disease”, in German also as “kissing disease”.

A particularly common route of infection is among small children, for example in kindergarten, where toys often get into their mouths and are exchanged with each other. Particularly “kiss-active” population groups such as young adults are also infected more frequently (“student fever”). 95 percent of people over 30 are infected with the glandular fever pathogen.

Other ways of infection, such as sexual intercourse, blood transfusions or organ donations are also possible, but far less common.

Mononucleosis: incubation period

The incubation period, i.e. the period between the infection and the onset of the disease, is long in glandular fever. There are usually four to six weeks between infection and the onset of the disease. During this time, however, the infected person can already infect other people without realizing that they themselves are ill.

How long is mononucleosis contagious?

Freshly infected people pass the virus on particularly easily. In this phase, a particularly large number of pathogens are excreted via the saliva. This is also the case for a long time after the symptoms have subsided. In order not to infect others, you should therefore be cautious about kissing in the first few months after the initial infection and avoid unprotected sexual intercourse.

Mononucleosis – how long is it contagious?

A person who has been infected once with glandular fever remains a carrier of the virus for life. The immune system then keeps the pathogen in check, so that the disease usually does not break out again.

However, the virus is increasingly released into the saliva again from time to time. All virus carriers can therefore infect others for life, even after the symptoms have subsided.

Infection with mononucleosis during pregnancy

There is evidence that primary infection during pregnancy is associated with a higher rate of miscarriage or birth defects. However, most women of reproductive age contracted the Epstein-Barr virus long before they became pregnant. As a result, very few are infected for the first time during pregnancy.

If the mother has already been infected with EBV, she also transfers her protection against the virus to the newborn. This lasts for the first six months of the infant’s life. As a rule, the child can only become infected afterwards.

Mononucleosis: investigations and diagnosis

The diagnosis of glandular fever is often difficult. Main symptoms such as a sore throat, fever and swelling of the lymph nodes also occur with simple flu-like infections and colds. In many cases, glandular fever is therefore not recognized at all or is recognized only late.

A specific examination for glandular fever is usually only carried out when the fever does not go down or the patient has complained of exhaustion for weeks or a severe sore throat does not subside.

The central aim of the investigation is to find out whether viruses such as the Epstein-Barr virus or bacteria such as streptococci are causing the symptoms. Antibiotics only help with bacterial infections, but not with viral infections. They would even unnecessarily burden the patient.

Physical examination

Throat exam: During the physical exam, the doctor will first examine the throat and tonsils. In glandular fever, they are reddened and often very swollen. The deposits also provide an indication of the type of infection: while they look more like spots in bacterial streptococcal tonsillitis, they appear white and flat in glandular fever.

Palpation of the lymph nodes: By palpating the neck under the angle of the jaw, the armpits and the groin region, the doctor can determine whether and which lymph nodes are swollen.

Scanning the spleen: In glandular fever, the spleen often swells to such an extent that the doctor can clearly feel it from the outside.

Throat swab: A throat swab can be used in the laboratory to determine whether bacteria are the cause of the disease. However, if the smear contains the Epstein-Barr virus, it is not sufficient for a reliable diagnosis of glandular fever. The pathogen is not only found in an acute infection on the mucous membrane. It can also be detected if the virus has been in the body for a long time and has only been reactivated.

Diagnosis by blood test

Antibodies: Specific antibodies against the Epstein-Barr virus can be detected in the blood for a reliable diagnosis of glandular fever.

Deformed lymphocytes: A blood test can also be used to determine whether these white blood cells have changed. Since they have to be regenerated en masse during infection, many of them are initially somewhat deformed. For this reason they are also called Pfeiffer cells or atypical lymphocytes.

Elevated liver enzymes : If the liver is affected by the virus, a blood test will also show an elevated level of liver enzymes (transaminases).

Mononucleosis: treatment

Mononucleosis is a viral disease. Antibiotics therefore do not help because they only work against bacterial infections.

So treatment focuses on relieving symptoms such as pain, difficulty swallowing, and fever. For this purpose, the usual agents such as ibuprofen , acetylsalicylic acid or paracetamol are used .

An important treatment principle for glandular fever is physical rest. This significantly reduces the risk of serious complications. The relief, which includes a strict ban on sports, should be maintained for a while even after the acute symptoms of the disease have passed.

If complications arise, further treatments may be necessary. If the pharyngeal mucosa swells up dangerously or if symptoms such as exhaustion and fever are very pronounced, treatment is also given with cortisone or other active ingredients that dampen the activity of the immune system.

A ruptured spleen must be operated on immediately, otherwise the patient threatens to bleed to death.

You can read what else is important in the treatment of glandular fever in the article glandular fever – treatment .

Mononucleosis: disease course and prognosis

Mononucleosis lasts up to three weeks. It usually heals without any lasting consequences. However, if there is a suspicion of complications or if the blood values ​​deteriorate dramatically, patients are treated in the hospital for monitoring.

In very rare cases, glandular fever becomes chronic. That is, the symptoms persist for months or even years. Only very rarely does mononucleosis lead to permanent damage due to complications such as liver inflammation and meningitis.

It is assumed that EBV infection increases the risk of some blood cancers (e.g. B-cell lymphoma, Burkitt’s lymphoma, Hodgkin’s disease).

Mononucleosis: what you can do yourself

Since the Epstein-Barr virus is very widespread in the population (the “infection rate” is 95 percent), one can hardly protect oneself against it. In the event of illness, however, you can do a number of things to prevent a serious course of glandular fever.

avoid alcohol

The infection also often puts a significant strain on the liver. You should therefore strictly avoid alcohol during the illness phase so as not to put additional strain on the liver. In some cases, the liver values ​​remain elevated for months, so that regular blood tests are necessary and you should avoid alcohol even after the symptoms have subsided in order to avoid permanent liver damage.

adjust medication

Since many medicines are also broken down in the liver, some active ingredients must be replaced by less liver-damaging substances for the duration of the disease in consultation with the doctor.

Exercise caution!

In the acute phase or in the case of severe infections, you should refrain from doing any sport at all.

If the spleen swells severely in glandular fever, there is a risk that the organ, which is very rich in blood, will rupture due to physical exertion or external violence. This causes severe internal bleeding that can be life-threatening. Therefore, contact and martial arts should be strictly avoided in the acute phase of the disease.

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